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Date run 2/16/2818 10:44:56AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report 95021 <br /> Run by is Pagel <br /> Facility Information as of 2/16/2018 <br /> Record Selection Criteria: Facility ID FA0024451 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) J ✓/"a <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : <br /> Owner ID OW0023026 New Owner ID <br /> Owner Name SAYBROOK CLSP LLC <br /> Owner DBA <br /> OwnerAddress 303 TWIN DOLPHIN DR 600 <br /> REDWOOD SHORES, CA 94065 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 303 TWIN DOLPHIN DR STE 600 <br /> REDWOOD SHORES, CA 94065 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0024451 <br /> Facility Name CENTRAL LATHROP SPECIFIC PLAN <br /> Location 783 SPARTAN WAY <br /> LATHROP, CA 95330 <br /> Phone 650-632-4522 <br /> Mailing Address 303 TWIN DOLPHIN DR STE 600 <br /> REDWOOD SHORES, CA 94065 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 650-6324522 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0045636 NewAccount ID: <br /> Mail lnvoicesto Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SAYBROOK CLSP LLC (Circle One) <br /> Account Balance as of 2/16/2018: $172.00 <br /> (Circle One) <br /> Transferto Activeimaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0542527 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PI-S[EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify,that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State and'or <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date /_/ <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date_/ / <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> EHD Staff: Date Account out: b6 Date / / �L/]; /� <br /> COMMENTS: Invoice#: 30.E r 2, <br /> d�� 2831 ?C— L'Zekj-. ' �,, ,� ,.- cll -� <br />